5 steps to safer surgery part 1 elearning PDF

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My lectures notes + additional learning material when I studied Adults with Complex Needs as a module for my BSC Adult Nursing Degree from 2014-2017....

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5 steps to safer surgery: Part 1 (elearning) Efficiency in the operating department - Arakelian, et al (2011) proposes efficiency in the operating department is valued and measured in varying ways by both the individual practitioner and the organisation concerned; however, what is generally agreed is that the quality of care a patient receives is a vital ingredient of efficient practice. While efficiency should of course be dovetailed with safety, the current emphasis in the NHS of achieving high patient ‘through-put’ alongside minimising hospital costs and increasing positive outcomes in terms of a patient and resources perspective, must nevertheless be married to the concept of patient safety as the central focus of healthcare practice. In relation to the quality of care patient receives in the operating department, clearly delivering safe care is crucial, therefore the drive for efficient use of resources by they people (staff), time or practicalities, foremost and in perpetuity, must be centred in policy that is focused on patient safety.

The origins, purpose and principals of the WHO surgical safety checklist - The origin of the WHO Surgical Safety Checklist, (SSC), was nested in a growing global awareness and concern about compromises to patient safety during hospital treatment (Haynes, et al., 2009; Haynes, et al., 2011). Prior to the development of the SSC, the organization had focused on implementing initiatives associated with a range of healthcare needs, for example, acute and critical care issues i.e. 'The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care' (WHO, 2005). This approach was a global effort to reduce mortality and morbidity rates by improving access to enhanced healthcare facilities while emphasising the need for quality of care (WHO, 2005). Nevertheless, other sentinel events occurring worldwide associated with surgery such as; surgical site infection (SSI) unsafe anaesthesia and poor communication within the surgical team, were recognised as contributory factors to mortality and morbidity rates and were part of the driving forces to develop mechanisms that would reduce risks to surgical patient safety, (WHO, 2008). The 'Surgical Safety Checklist' was developed not only to be a practical 'user-friendly' step by step guide to ensuring a safe surgical patient journey but also to address the underlying issues invariably associated with achieving surgical patient safety such as, ensuring good communication, enhancing effective team working and leadership, and promoting a positive safety culture and climate (Haynes, et al., 2011). Juxtaposed with the WHO's efforts, in the United Kingdom (UK) the National Patient Safety Agency (NPSA) launched a national patient safety campaign in 2008 (NPSA, 2008) focused on improving patient outcome by enhancing patient safety. The agency identified "five interventions" designed "..to help NHS staff bring about change"(NPSA, 2011:21) in relation to the longstanding "..cultural and behavioural.."(NPSA, 2011:4), approaches to patient safety in the NHS, whereby staff had a tendency to expect and thereafter react to patient error and harm, rather than be proactive in its prevention. The 'interventions' (NPSA, 2011) focused on i.e. fostering effective leadership, recognising the physiologically deteriorating patient, using evidence to inform practice, reducing patient harm from high risk medicines, and improving care for patients undergoing surgical

procedures with the use of an adapted WHO Surgical Safety Checklist (NPSA 2009a).This Checklist became mandatory in the UK. 

This general patient safety initiative proved to be very successful and was followed by the 'Never Events' policies of 2009 (NPSA, 2009b,) and the Department of Health (DH) updated, 'Never Events' list (DH, 2011). The 'Never Events' identified a range of issues that must be prevented when delivering healthcare treatment and from a surgical perspective, highlighted two possible features namely 'wrong site surgery' and 'retained instrument post-operation'. 'Never Events' (DH, 2011), is explored further in the guided learning section of this activity.

Wrong site surgery - The possibility of wrong site surgery is a major concern for the perioperative team and this feature has been selected as a focus and example of the importance of using safety measured identified i.e. SSC and the NPSA’s ‘Five steps to safer surgery’ policy adaption, to ensure safe surgical practice. Which surgical specialities report the most frequent wrong site surgery? Wrong site surgery as reported to the Joint Commission for Accreditation of Hospitals is most prevalent in orthopaedic and podiatric procedures – USA hospital + 41% of total reported followed by general surgery (20%), neurosurgery (14%) and urological surgery (11%). Reference – Dagi et al (2007:369). Other surgical specialities report wrong site surgery across the range of surgical specialities and Dagi, et al (2007:369) cites UK data identifying 17 “wrong-site neurosurgery” episodes “reported over” a 2-year period from “34 hospitals”. In the UK, Dagi (2007:369) reports that ins 2005 the (JCAHO) ranked wrong site surgery second in overall frequency (12.5%) of reported sentinel events exceeding perioperative complications and medication error.

Contributing factors to wrong site surgery - 1. Failure to fully implement the safety checks i.e. ward preparation was incorrect as the wrong site was marked, and ward documentation was completed inaccurately: - the surgical site should have been checked for accuracy against the consent to treatment document and the patient’s medical notes. 2. Other issues include factors concerned with communication, lack of concentration and attention to vital patient detail, rigid hierarchy, poor leadership (Edmonson, 2003) and a poor safety organizational culture-climate. Factors associated with the possibility of wrong-site surgery - JCAHO (2007) associated many factors with a higher possibility of wrong-site surgery. “Emergency surgery, morbid obesity patients, physical deformity, unusual equipment or setup in OR, multiple surgeons, multiple procedures, unmarked site, not requiring verification in the OR, not requiring a verification checklist, incomplete patient assessment, staffing problems, distractions, lack of pertinent information, problems in organizational culture”.

Summary - Ensuring patients are safe when they are in the operating department is an essential element of daily practice. Resident perioperative practitioners have a duty of care for patient's (Nursing and Midwifery Council (NMC), 2008; Health & Care Professions Council (HCPC), 2012), as indeed do visiting surgeons and anaesthetists, (General Medical Council (GMC) 2010).

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Ensuring practitioners understand and re-enact the principles and practices of the Surgical Safety Checklist as part of the 'Five Steps to Safer Surgery' approach, is a primary responsibility of each and every member of staff....